- Guidehouse (San Marcos, CA)
- …+ Files adjusted billings based on audits and or changes in diagnosis or DRG . + Updates patient accounts with corrected demographic or insurance information. + Works ... all rejection and payer audit reports within 48 hours of receipt taking whatever action may be required to obtain account resolution. + Monitors all denials for trends and issues and reports finding to supervisor. + Bills or re-bills as necessary. + Ensures… more
- LA Care Health Plan (Los Angeles, CA)
- …validation of accuracy and completeness of ICD, Rev Code, CPT, HCPCs, APR, DRG , POA, and all relevant coding elements. Audits can include inpatient, outpatient, and ... professional claims. Serves cross functionally with Utilization Management, Medical Directors, and other internal teams to assist in identification of overpayments as well as other projects. Serves as SME for all Payment Integrity functions to include both… more
- Veterans Affairs, Veterans Health Administration (Los Angeles, CA)
- …Initiates discharge planning upon admission. Applies InterQual Criteria and/or DRG and discusses with the interdisciplinary team. Attends daily Interdisciplinary ... meetings/rounds. Educates the patient, the family or family caregiver, and members of the interprofessional health care team. Coordinates and ensures appropriate resources are in place prior to discharge. Implements care interventions. Provides referrals to… more
- Blue Matter (San Francisco, CA)
- …+ Development of payer / provider contract strategy simulation models + Inpatient DRG analysis + Cost threshold analysis in support of NTAP applications + Analytics ... in support of patient services (PAP and co-pay) programs + Analytics in support of BD&L programs Desired Experience and Skills + Demonstrated expertise in quantitative modeling involving pharmaceutical assets + Demonstrated experience in execution of… more
- CenterWell (Sacramento, CA)
- …action. The Medical Coding Professional confirms appropriate diagnosis related group ( DRG ) assignments. Analyzes, enters and manipulates database. Responds to or ... clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous… more
- UCLA Health (Los Angeles, CA)
- …+ Proficiency in ICD-10-CM/PCS and CPT-4/HCPCS coding, with strong knowledge of DRG and APC payment methodologies + Familiarity with AHA Coding Clinic and ... CPT Assistant + Experience with Epic/CareConnect, 3M 360 Encompass, SMART, and Cirius systems + A bachelor's degree in a related field (preferred) + RHIT or RHIA certification (preferred) + Strong organizational, communication, and leadership skills to… more
- CommonSpirit Health (Rancho Cordova, CA)
- …as Medicaid and Medicare + Working knowledge of various reimbursement methodologies including DRG 's, per diems, RVU's + Ability to effectively work within a highly ... matrix-oriented organization **Overview** Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic… more
- Datavant (Sacramento, CA)
- …with strong problem-solving skills. + Expert knowledge of coding guidelines, DRG assignment, and reimbursement methodology. + Strong analytical and problem-solving ... abilities. + Effective communication and leadership skills. + Proficiency in productivity and audit tracking tools. + Strong Prioritization and Time Management Skills **What We Offer** + Benefits for Full-Time employees: Medical, Dental, Vision, 401k Savings… more
- Stanford Health Care (Palo Alto, CA)
- …and coding systems, particularly the Outpatient Prospective Payment System (OPPS), DRG 's, MediCal/Medicaid APG Grouper, HCPCS and CPT-4 coding schemas. + Knowledge ... of Medicare, Medicaid and other third-party billing coverage and compliance issues. + Knowledge of CMS and State coding standards and charge capture (technical and professional) guidelines. + Knowledge of Medicare documentation sources and regulatory… more
- Sutter Health (San Francisco, CA)
- …Care. SNF, LTAC, B&C, Sub-acute, Acute rehab. + General Knowledge of coding and DRG assignment process preferred. + Must be able to effectively communicate with and ... promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners. + Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients… more